February 19: The Randomised Evaluation of COVID-19 Therapy (RECOVERY) Trial, the world’s largest clinical trial for COVID-19 treatments, has now expanded internationally with Indonesia and Nepal among the first countries to join, according to the University of Oxford. The university said in a statement that the first patients have already been recruited for the trial.

“The RECOVERY trial has been an enormous success, enrolling over 36,000 patients and delivering clear results on six treatments already,” the statement quoted Professor Peter Horby of Oxford University as saying.

“By building on this success through international partnership we can speed up the assessment of novel treatments, increase the global relevance of the trial results, build capacity, and reduce wasted efforts on small uninformative studies,” added Horby, professor of Emerging Infectious Diseases and Global Health in the Nuffield Department of Medicine at the University of Oxford, and joint chief investigator for the trial.

Professor Horby is of the view that it is particularly important to find readily available and affordable treatments for COVID-19 that can be used worldwide. RECOVERY International will “help us” to identify effective treatments that can be used in less well-resourced settings, he added.

The RECOVERY trial was launched rapidly in the UK in March 2020 to investigate whether any existing treatments were effective against COVID-19. The statement added that the trial is open to all patients admitted to NHS hospitals with COVID-19, with over 36,000 patients recruited so far.

According to the university, the trial has already delivered results that have changed clinical care, including the findings that the inexpensive steroid, dexamethasone, and the anti-inflammatory treatment, tocilizumab, significantly reduce the risk of death when given to hospitalised patients with severe COVID-19.

In Indonesia and Nepal, the trial will initially focus on the treatments aspirin and colchicine, since these are readily available and affordable but, like RECOVERY in the UK, the trial is adaptive and new drugs will be added over time, the statement further says.

 “The expansion of RECOVERY internationally has been made possible thanks to the longstanding work of the Oxford University Clinical Research Unit (OUCRU), which has campuses in Kathmandu in Nepal (OUCRU Nepal) and Jakarta in Indonesia (Eijkman-Oxford Clinical Research Unit, EOCRU).”

OUCRU Nepal exists in partnership with Patan Academy of Health Sciences and Patan Hospital in Kathmandu and the trial is being delivered in collaboration with the Nepal Health Research Council.

“The Nepal team is super-excited to be aligned with Oxford University's RECOVERY, the largest COVID-19 drug trial in the world so that these ground-breaking findings also become relevant in the context of low- and middle-income countries,” the statement quoted Professor Buddha Basnyat, Director of OUCRU Nepal, as saying.

 The Co-lead from Nepal, Dr Pradip Gyanwali, member secretary of the Nepal Health Research Council adds that Recovery International has excellent potential for being very useful for Nepal.

 Dr Nick Cammack, COVID-19 Therapeutics Lead at Wellcome, said, “This new research will also help us to understand how other diseases that are endemic in some countries, such as TB and HIV, can affect COVID-19 and its treatments.”

He added that COVID-19 can be a preventable and treatable disease, but only if we invest in research now.

“A pipeline of new treatments is essential if we are to reduce further deaths and suffering, and to keep pressure off health systems. Investing in research into a wide range of treatments, alongside vaccines and testing, and ensuring all advances are fairly available globally, remains our only exit from the pandemic.”